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2860 Saddle Bronc Cir Douglasville GA 30135-8957 | |
| (877) 221-6843 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 2860 Saddle Bronc Cir, Douglasville, Georgia |
| Authorized Official Name and Position | Andrionna Williams (CASE MANAGER) |
| Authorized Official Contact | 8772216843 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
2860 Saddle Bronc Cir Douglasville GA 30135-8957 Ph: (877) 221-6843 | 2860 Saddle Bronc Cir Douglasville GA 30135-8957 Ph: (877) 221-6843 |
| NPI Number | 1013442995 |
|---|---|
| Provider Enumeration Date | 04/27/2017 |
| Last Update Date | 04/27/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013442995 | NPI | - | NPPES |
| 1811262488 | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 102461 (Georgia) | Primary |
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